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EMINENT AND FIDDLING ISSUES AMONG PHYSICAL THERAPY
STUDENTS
Syamala Maheshwari1, Vadivelan.K2, Shrisruthi.S3 1
Post graduate student, SRM College of Physiotherapy, SRM Institute of Science and
Technology, Kattankulathur, Kancheepuram, Chennai- 603203, Tamil Nadu, India.
2
Professor, Faculty of Medical and Health Science, SRM College of Physiotherapy, SRM
Institute of Science and Technology, Kattankulathur, Kancheepuram,
Chennai-603203, Tamil Nadu, India.
3
Assistant Professor, Faculty of Medical and Health Science , SRM College of Physiotherapy,
SRM Institute of Science and Technology, Kattankulathur, Kancheepuram,
Chennai-603203, Tamil Nadu, India.
shrisrus@srmist.edu.in
ABSTRACT:
BACKGROUND: Physiotherapy practice has been found in the last four decades with a helping hand in
medical profession, in recent trends physiotherapy field has been emerging and the students are also increasing day by day. The physical therapy students have different dimension in the field and find some issues regarding to it.
INTRODUCTION: The student physiotherapist has varied thoughts and crises regarding the ethical issues
where they lack in combining clinical practice and academics. The lack of knowledge in self-identity to client and social focus makes the students a step back in the decision making. The major themes are 1. Identification of ethical dilemma, 2. Link between clinical and ethical decision making, 3. Therapist –client relationship.
AIM OF THE STUDY: The aim of the study is to determine ethical issues among student physiotherapists
in clinical settings.
METHODOLOGY: The study is a qualitative study, a direct interview method is done by three board
members and the eminent and fiddling issues are sorted out through discussion.
CONCLUSION: The ethical issues relate predominantly to students’ interpersonal relationships with clients
or co-workers and to the exploration of rules and responsibilities as emerging physiotherapists.
KEY WORDS: Physical therapy students, ethical issues, clinical practice.
I. INTRODUCTION:
Ethics is derived from Greek word “ethicos” which means “custom”. Ethics in physiotherapy can defined as moral code of conduct, whereas bioethics is defined as the investigation of the moral issues raising up out of the advances in the science and the medical field. Bioethics is concerned about the moral inquiries that emerge in connection among the life sciences, medicine, biotechnology, clinical morals, philosophy and many other fields. In recent years the profession of physical therapy has increased its autonomy in decision making and has expanded its role in patient care. This increase in autonomy has increased the ethical considerations for physical therapists and each have different opinions about analyzing the issues. Lack of analyzing the ethical practice, the future generation therapists are having the stigma of following the superiors. The implementation of professionalism through ethical pathway, still remains a query and it affects the social status in the society,
www.turkjphysiotherrehabil.org 4277 creating dishonesty to the profession unknowingly. Until or unless each physiotherapy students gets an exposure to professionalism, the knowledge about the ethics remains stagnant and modifications cannot be explored. To guide towards the ethical practice the APTA has given the 7 core values which can help the young physical therapists.
ACCOUNTABILITY:
Accountability is the answerability, it has expanded beyond the basic definition of "being called to account for one's actions". It is frequently described as an account-giving relationship between individuals.
PROFESSIONAL DUTY:
Professional duty is the area of legal practice that encompasses the duties of attorneys to act in a professional
manner, obey the law, avoid conflicts of interest, and put the interests of clients ahead of their own interests.
COMPASSION/CARING:
Compassion is the one which motivates the individuals to make a special effort to help the physical, mental, or passionate agonies of another and themselves empathy is frequently given a property of "profundity", "force", or "energy". Compassion includes "feeling for another" and is a forerunner to compassion, the "feeling as another" limit with regards to better individual focused demonstrations of dynamic empathy; in like manner speech dynamic empathy is the longing to lighten another's suffering.
EXCELLENCE:
Excellence is the ability or quality which is uncommonly acceptable thus outperforms normal guidelines. To excel in the field an individual should put a tremendous effort and should always be a part of learning process.
INTEGRITY:
Integrity is the trustworthiness is the act of being straightforward and demonstrating a reliable and solid adherence to solid good and moral standards and qualities. In morals, respectability is viewed as the genuineness and honesty or precision of one's activities. The word uprightness advanced from the Latin modifier number, which means entire or complete. In this specific circumstance, trustworthiness is the inward feeling of "completeness" getting from characteristics, for example, genuineness and consistency of character.
ALTRUISM:
Altruism is the standard and good act of worry for satisfaction of other individuals or creatures, bringing about a personal satisfaction both material and otherworldly. It is a customary ethicalness in numerous societies and a center part of different strict conventions and mainstream perspectives, however the idea of "others" toward whom concern ought to be coordinated can change among societies and religions.
Steinberg suggests a definition for altruism in the clinical setting that is "intentional and voluntary actions that aim to enhance the welfare of another person in the absence of any quid pro quo external rewards".
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AIM OF THE STUDY:
This study was conducted to analyze the ethical issues encounters by the physical therapy students who are being new to the clinical practice. After analyzing the issues classify them into the major and minor issues, is the secondary aim of the study. The need to recognize and explain moral issues inside a wellbeing calling increments as the calling accept obligation regarding those regions of direct patient consideration in its space. The physical specialist today, in characterizing the cutoff points of his lawful and expert self-governance, must look at the act of his calling from a moral purpose.
PROCEDURE:
The study is the Non-experimental Qualitative study. Convenient sampling was used to select the participants, with a sample size of 25 which included the 12 students of MPT 1st year and 13 undergraduate Interns who are new to the practice in clinical settings. The individuals who are excluded from the study are Undergraduate physiotherapists and Physiotherapy professionals of experience more than 2 years. The reason behind excluding these individuals who are with more than 2 years of experience is that they might have been exposed to various ethical issues and can overcome with their past experiences or the expert suggestions.
Participants were included according to the inclusion and exclusion criteria with the informed consent and a direct interview was conducted. The responses acquired from the participants would be analyzed and categorized by a panel of three board members: senior physiotherapist, community medicine department and public health profession having 15 years of experience in both the clinical and academics.
These interviews were taken in the period of 6 weeks, and every week the qualitative analysis of interviews were compiled and analysis was done describing their clinic experience and ethical practice.
Participants demographic data was documented along with their duration of experience in clinical practice. In the direct interview, participants were asked 20 questions and responses given by the participants was recorded and documented for data analysis by the panel members. These 20 question were categorized into 4 domains and each of the domain contained 5 questions.
4 domains were created and questions was asked based on these categories, they are
1. Relationship with co-colleagues:
The relationship with colleagues is essential in a working sector, as individuality sometimes cannot be the only option and moving along with colleagues usually improve the knowledge sharing, self-treating, and to clarify the problem faced by the therapist. A good colleague relationship among physical therapy students can be a base to learn new things, get suggestions from others, working experiences etc.
2. Practical issues:
There are many students who prefer individual practice, but there chances of malconduct (practicing the wrong positions, techniques), which needs to be corrected in the initial period itself as it may lead to affect the patients further. And many techniques we use may be theoretical so when it comes to practice, many student face problem in demonstrating as well as implementing in practice.
3. Moral issues:
When it comes to moral practice, the main issues arises with colleagues as each have different opinions for treating a case or condition. The therapist treating the patient with a technique should not be a blinded one, evidence based practice is highly recommended, other than that giving false hope, complaining about the malpractice and misconduct by colleagues, superiors has been the hidden factors which need to enlighten and also solved for better professionalism.
4. Quality of life:
We asked about the quality of life as a student therapist, on basis of practice, most of them have reported there are many dignity or lack of respect among the rehab team, even the physician suggest the exercises and modalities as a physiotherapy treatment, while after learning to select the treatment better also, there is improper place to apply it and experience the trial. And many suggestions were on the income (salary), after completion of course, the
www.turkjphysiotherrehabil.org 4279 therapist has been paid very less comparative to working hours, incase of increasing the quality of practice is good then it indirectly improves the quality of work and develop in quality of life with satisfaction.
II. DISCUSSION:
After the interview session: we have found there are major and minor ethical issues, where major issues are considered in vision, whereas minor issues have been neglected. Student physiotherapist also reported that they face ethical issues, but they follow the practice done by the superiors. So, there may be ethical issues among all the physiotherapists which needs to be analyzed in future. The most common issues under all the domains were considered and divided into major and minor categories by the panel members.
DOMANS MAJOR MINOR
Relationship with colleagues Inequality
Respect and dignity
Encroachment
Practical issues Lack of documentation
Improper diagnosis
Informed consent
Moral issues Misconduct Reference for benefit
Quality of life Overutilization Improper recognition.
RELATIONSHIP WITH COLLEAGUES:
INEQUALITY: Most of the participants have quoted that they are facing inequality in the clinical setting. The most probable reason behind this might be the intension of the client to be attended by the senior therapist/expert, so that they get a better treatment. This would not leave the young physiotherapist with the required number of learning experiences and face difficulties to excel in the field.
RESPECT AND DIGNITY: This was the most every now and again referenced moral issue.
ENCROACHMENT is the minor issues under this domain which is explained as one professional to enter by gradual steps or by stealth into the possessions or rights of another profession.
PRACTICAL ISSUES:
LACK OF DOCUMENTATION: Documentation plays a crucial role in the client registration, assessment and treatment planning. Due to the lack of proper documentation the participants have fell in ethical and practical dilemma. On the other hand as there is less clinical exposure they also faced issues in documenting the client details/treatment plan.
IMPROPER DIAGNOSIS :
INFORMED CONSENT falls into minor category in this particular domain, which concerns the privilege of a grown-up individual to choose according to the willingness of the person. The individual must get data that is suitable and satisfactory information about study and how is it going to fetch them if there are any risks of participation/treatment protocol for choosing to participate/take the treatment.
Inspite, of knowing the importance of the informed consent the student physiotherapists are sometimes facing issues in acquiring it, many of the students quoted that reason is lack of time, inability to communicate the risks and benefits due to less experience.
MORAL ISSUES: MISCONDUCT:
REFERENCE FOR BENEFIT is the minor issue of this domain which is defined as referring or transferring a client for the financial benefit, which sometimes is falling out of the ethical practice; where some professionals are referring the cases only for the purpose of benefit.
QUALITY OF LIFE:
OVERUTILIZATION is the most burning issue which all the participants have quoted; most of them have undergone this issue which is characterized with lower remuneration to the service which they have rendered.
www.turkjphysiotherrehabil.org 4280 IMPROPER RECOGNITION is the common among all the minor ethical issues, the participants have quoted that they are not recognized as the professional therapist most of the times, might be due to the expert domination or the ignorance of the clients.
III. CONCLUSION:
Ethical issues are encountered by majority of the students in clinical settings. They occur with high frequency and impact student learning. The ethical issues relate predominantly to students’ interpersonal relationships with clients or co-workers and to the exploration of rules and responsibilities as emerging physiotherapists. Though ethics has been included in academic curriculum the budding physiotherapist are unaware of implementing it in clinical practice.
LIMITATIONS:
As it was a direct interview process, it was a time taking process. The sample size was small.
RECOMMENDATIONS:
A large sample can be taken. Study duration can be extended.
A self-evaluation questionnaire can be framed.
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